Thrombectomy catheter

ABSTRACT

A target substance, such as a thrombus, is removed from a patient&#39;s body via minimally invasive technique. A catheter is maneuvered and positioned near the target substance. The catheter may have a soft, atraumatic tip constructed from a metallic backbone covered by a polymer. Target substances are drawn into the catheter via an aspiration source. Near the catheter&#39;s distal end, a blade and opposing surface are housed within the catheter, and the blade moves relative to the opposing surface within the catheter lumen in order to fragment the target substance. The substances are fragmented within the catheter into discreet and relatively uniform particles. The aspiration source, which helps ensnare target substances, also serves to evacuate the substance fragments from the patient&#39;s body.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional PatentApplication No. 62/584,326 (Attorney Docket No. 41507-728.201), filedNov. 10, 2017, and entitled “Thrombectomy Catheter,” the contents ofwhich are fully incorporated herein by reference.

BACKGROUND OF THE INVENTION 1. Field of the Invention

The present invention relates generally to medical devices and methods.More particularly, the present invention relates to devices and methodsfor disrupting, collecting, and removing occlusive material from bloodvessels and other body lumens.

Many diseases cause an undesirable buildup of occlusive material.Thrombosis and atherosclerosis are common ailments that result from thedeposition of thrombus and clot on the walls of blood vessels. Whenhardened, such deposits are commonly referred to as plaque. Thesedeposits restrict blood flow and pose a risk of fragmenting into theblood stream. If this occlusive material travels to the heart, brain, orlungs, the event can be fatal.

An example of one such disease state is Deep Venous Thrombosis (DVT),where blood clots form in the deep (non-superficial) veins of the body,typically within the legs. DVT is commonly characterized by the build-upof large volumes of tough, chronic clot which impedes venous flow. Everyyear in the U.S. about 700,000 people are diagnosed with DVT andapproximately 200,000 people die of pulmonary embolism, a complicationof DVT. Sixty to seventy percent of patients with DVT eventuallyexperience post thrombotic syndrome (PTS) as a result of damage to thevenous valves secondary from the cellular response and from overgrowthcaused by the thrombus. The damage characteristic of PTS can also leadto chronic venous diseases (CVD) caused by Chronic Venous Insufficiency(CVI). Over 7,000,000 in the U.S. suffer from CVI, a painful anddebilitating disease that affects the superficial and deep veins of thelegs. Complications associated with CVI include varicose veins,bleeding, ulcerations, severe swelling, deep vein thrombosis, andpulmonary embolism. These diseases are reoccurring and can proliferateinto interrelated diseases. The risk for delayed reoccurrence is commonacross disease states that include the buildup of thrombus, plaque, orother occlusive material. As such, there exists a need for an effectivedebulking treatment that not only addresses the complication but alsoprevents the proliferation and reoccurrence of further, relatedcomplications.

The removal of occlusive material from blood vessels and other bodylumens has commonly been approached through treatments based on drugadministration, filter implants, and catheter based removal. Althoughmany disadvantages of the prior art are neither obvious nor well known,all methods currently in use suffer from one or more disadvantages.

Anticoagulant drugs, such as Heparin, are the most commonly prescribedtreatments for DVT. The administration of anticoagulants prevents theclot from growing and relies on the body's lysing processes to eliminatethe clot. This process is expensive, slow acting, not effective againstlarge or complete occlusions, and risks residual clot entering the bloodstream to cause venous damage elsewhere, which can lead to PTS.

Thrombolytic drug infusion directly into the clot is an alternativeapproach. Thrombolytics such as tPA work to actively break down thefibrin backbone of the clot. This destroys the clot more quickly, butintroduces additional cost, risks clot fragmenting into the bloodstream, and involves a high risk of hemorrhage, which can be fatal. Therisk of bleeding complications typically necessitates administration ofthe drug in a hospital setting where the patient is held overnight orfor several days for observation. For many patients, such as those whomhave recently under gone surgery, have a high risk for bleeding, or arepregnant, the risk of hemorrhage makes them ineligible to receivethrombolytic drugs.

Thrombus filter implantation is an additional method of treatment. Thesefilters are surgically implanted, typically into the inferior vena cava.Filters function to capture clot and then allow the body's lysingprocesses to eliminate the clot. Although the use of these filters cangreatly reduce the likelihood of clot fragments traveling to the heartor lungs, they often require the use of anticoagulant drugs in concertand therefore entail all the complications described above. Furthermore,poor rates of physician follow-up and patient compliance result in a lowpercentage of filters ever being retrieved. Unretrieved filters are acommon cause of inferior vena cava thrombosis. Filters may also clog,restricting blood flow and in some cases causing full occlusion. Thus,thrombus filters can cause the very problems they are intended to solve.

Catheter-based interventions present an alternative treatment method.Catheters or catheter-based devices are percutaneously introduced intoblood vessels and are maneuvered into direct contact with a targetsubstance. For newly formed thrombus or unadhered and small plaque, thesubstance may be removed through a catheter via aspiration, mechanicalcapture, or other means. This approach has the benefit of quicklyremoving the target substances and the benefit of leaving behind littleresidual material, which could otherwise lead to reoccurrence orproliferation of related diseases. However, the limitations on the typeand volume of occlusive material which can be successfully removed makeit a non-viable approach to many disease states, such as DVT whichtypically involves large, tough thrombus burdens.

Some catheter-based devices include rotating blades, high pressure waterjets, laser ablation, or other aggressive means of breaking up thetarget material. Such methods are common in atherectomy-specific toolswhere the occlusion is formed by well-adhered plaque. Many such devicessuffer from at least one of two serious shortcomings. Firstly, themethods of removing targeted substances once the substances arefragmented are either ineffective or non-existent. Even in devices thatdo possess a debulking strategy, these devices often include smalllumens that are prone to clogging or inefficient pressure gradients thatfail to pull dislodged clot or plaque into the system. If not removed,dislodged clot or plaque is released into downstream blood vessels andposes a risk for further complications. Secondly, the more aggressivedevices, such as those using rotating blades to fragment tough clot orplaque, are often exposed within the body lumen in a manner that risksdamaging the vessel wall.

Such systems and techniques, however, frequently suffer fromdisadvantages and shortcomings such as vessel damage, clotfragmentation, blood loss, prolonged surgery, and/or catheter clogging.

For the reasons discussed above, there has existed a long felt and unmetneed for methods and apparatus that remove a wide range of occlusivematerials, including at least clot, thrombus, and atheroma, quickly andsafely. In particular, it would be desirable to provide systems andmethods which remove such occlusive substances quickly, which safelyincorporate apparatus for fragmenting the occlusive substances, whichenhance digestion of the occlusive substances, which utilize aspirationto limit release of the fragmented substances, and which can be safelyintroduced into a patient's vasculature. The invention herein describedand claimed, and its various embodiments, present solutions that satisfyat least some of these objectives.

2. Background of Related Art

Atherectomy catheters having rotating, cylindrical cutting blades aredescribed in U.S. Pat. Nos. 4,781,187; 5,507,760; 9,687,266 and9,687,267. Other thrombectomy and atherectomy catheters and protocolsare described in U.S. Pat. Nos. 5,419,774, 5,192,291, 6,010,449,6,638,233, 8,628,549 and 4,177,797.

SUMMARY OF THE INVENTION

A thrombectomy catheter for use in a subject's vasculature includes arotating and axially movable, cylindrical cutting body. The thrombectomydevice is especially suited for removal of tough, chronic thrombus suchas that which is found in cases of Deep Vein Thrombosis. We havedeveloped a catheter-based device which relies on automated actuation inorder to facilitate rapid thrombus removal. The automated motion ishoused in a handle that is operated by the physician user. The systemsand methods disclosed herein remove target substances quickly, safelyhouse an apparatus for fragmenting target substances, optimizes thrombusdigestion, utilizes aspiration to limit release of fragmented clot, andcan be safely introduced into a patient's vasculature.

The device includes a catheter containing a cutting tip affixed to amandrel. Rotational motion and linear actuation are simultaneouslyapplied to the cutting tip mandrel, resulting in the mastication ofthrombus within the catheter. The system relies on the use of aspirationvia the Penumbra pump to draw thrombus into the catheter and facilitatedebulking once the thrombus mass has been broken up by the rotatingcutting tip. An attached handle provides the source of the rotationaland linear motion, as well as the connection between the catheter,cutting tip mandrel, and aspiration source. A device made according tothe design disclosed herein would not include “raised elements” or an“abrasive” surface in addition to the cutting edge.

In a first specific aspect, the present invention provides a system forremoving of one or more target substances, such as thrombus, clot,atheroma, plaque, and the like, from a body passageway, such an artery,a vein, or other blood vessel or body lumen. The system comprises acatheter having a lumen, a proximal end, and a distal end. The proximalend of the lumen is typically configured to be fluidly coupled to anaspiration source, such as a pump or other vacuum source. A cuttingmember having a leading cutting edge is disposed in the lumen andconfigured for axial motion, typically reciprocation, within the lumenbetween a proximal-most position and a distal-most position. An opposingsurface is disposed within at a distal location in the lumen, and theleading cutting edge of the cutting member is configured to contact theopposing surface and to shear target substance disposed between theleading edge and the opposing surface when the cutting member ispositioned in the distal position. The cutting member and the opposingsurface are typically configured to fragment a targeted substance intofragments having discreet and relatively uniform volumes upon axialmotion of the cutting member.

In specific embodiments, the cutting member is further configured forrotation and/or rotational oscillation, and the system may furthercomprise at least one motor coupled with the cutting member, wherein theat least one motor is configured to impart at least axial motion andoften both rotational motion and reciprocal axial motion to the cuttingmember. The at least one motor is may be configured to rotate thecutting at a speed of up to 3000 RPM, typically in a range between 1000RPM and 3000 RPM. The at least one motor may be further configured toaxially reciprocate the cutting member at a frequency of up to 6 Hz,typically in a range from 3 Hz to 6 Hz.

The cutting member is typically cylindrical with a leading cutting edgewhere the leading cutting edge will often be serrated with cuttingteeth. The opposing surface may comprise a cone disposed distal to thecutting member, wherein the cutting member is configured so that theleading cutting edge of the cutting member engages the a conical surfaceon the cone as the cutting member is advanced fully in a distaldirection. A base of the cone may be attached to a distal end of thecatheter and a pointed conical tip of the cone may be directedproximally. In some instances, the cone may be configured for rotationalmotion so that it can accommodate rotation of the cutting blade.

In further embodiments, the catheter includes an atraumatic tip. Theatraumatic tip may comprise a metallic backbone and a polymericmaterial. The metallic backbone may comprise a preselected angle or arc,or may comprise a wound spring.

In a second specific aspect, the present invention provides a system forremoval of one or more substances from a body passageway. The systemcomprises a catheter having a lumen, a proximal end, a distal end, and asidewall, where the sidewall comprises an aperture disposed near thedistal end of the catheter. A cone having a base and a tip is positionedat the distal end of the catheter, and the base of the cone is orientedtoward the distal end of the catheter while the tip of the cone isorientated toward the proximal end of the catheter. A distally facingcutting member is disposed in the lumen of the catheter, typicallyadjacent to aperture, and the cutting member is configured forreciprocal axial translation in both a distal direction toward the conein a proximal direction away from the cone.

In specific embodiments, this second system may further comprise a motorconfigured to impart axial motion to the cutting member. The cuttingmember may be further configured for rotation and/or rotationaloscillation, and the system may further comprises a motor configured toimparts both axial and rotational motion to the cutting member. Anaspiration source may be placed in fluid communication with thecatheter, and the cutting member is configured to rotate at a speed ofup to 3000 RPM. The cutting member may be further configured for axialtranslation at a frequency of up to 6 Hz.

In further specific embodiments, the cutting member may be cylindricalwith a leading cutting edge, where the leading cutting edge is serratedwith cutting teeth. The cone typically has a conical surface disposeddistal to the cutting member, and the cutting member is typicallyconfigured so that the leading cutting edge of the cutting memberengages the conical surface on the cone as the cutting member isadvanced fully in a distal direction.

In a third specific aspect, the present invention provides a method forremoving a target substance, such as thrombus, clot, atheroma, plaque,and the like, from a body passageway, such an artery, a vein, or otherblood vessel or body lumen. The method comprises providing a catheterincluding a lumen and a cone and a blade disposed in a distal end of thelumen. The distal end of the catheter is advanced to a target substancein the body passageway, and aspiration through the lumen is initiated todraw the target substance between a cutting edge of the blade and anopposing conical surface of the cone. The target substance is thenremoved by axially reciprocating the blade so the blade engages thetarget substance and shears the target substance against the opposingconical surface of the cone.

In specific instances, the blade is rotated in addition to beingreciprocated to enhance shearing of the target substance. The targetsubstance may be penetrated by a conical tip on the cone as the blade isaxially reciprocated to immobilize the target substance as it is beingsheared and to further enhance fragmentation of the target substance tofacilitate aspiration and removal. Removal is typically affected byinitiating aspiration through the lumen to draws the target substancethough an aperture in a sidewall of the catheter and then into a spacebetween the cutting edge of the blade and the opposing conical surfaceof the cone.

BRIEF DESCRIPTION OF THE DRAWINGS

An object of the present invention is to provide an improved apparatusand method for removing a target object from a body passageway. Afurther object of the present invention is to provide an improvedapparatus and method for removing a target substance from a bodypassageway, which is particularly useful for removing blood clotsquickly and safely.

These and other features, aspects, and advantages of the presentinvention will become better understood with regard to the followingdescription, appended claims, and accompanying drawings where:

FIG. 1 shows a perspective view of a thrombectomy catheter system inaccordance with one embodiment.

FIG. 2 shows a side, transparent, detail view of a distal most segmentof a system embodiment according to the invention.

FIG. 3 shows a perspective detail view of a component disposed at thedistal end of an embodiment according to the invention.

FIG. 4 shows a perspective detail view of an internal component of anembodiment according to the invention.

FIG. 5 shows a side view of another internal component, shown inisolation from a system according to the invention.

FIG. 6A-6C are transparent views of a distal region of a systemaccording to the invention, and represent a time-lapse illustratingmoving components of a system according to the invention.

FIG. 7 shows a step-by-step methodology for removing substances from thepassageway of a body in accordance with one embodiment.

FIG. 8 shows another step-by-step methodology for removing substancesfrom the passageway of a body in accordance with one embodiment.

FIG. 9A-9D illustrate an example of axial based shearing forces and therelatively uniform fragments those forces generate in an embodiment ofthe invention.

DETAILED DESCRIPTION OF THE INVENTION

In the following detailed description, drawings are referenced thatillustrate how specific embodiments of the present invention may bepracticed. These embodiments are described in sufficient detail toenable those skilled in the art to practice aspects of this disclosure,and it is to be understood that other embodiments may be utilized andthat structural changes may be made without departing from the scope ofthe present disclosure. Therefore, the following detailed description isnot to be taken in a limiting sense, and the scope of the presentdisclosure is defined by the appended claims and their equivalents.

As used herein, the articles “a”, “an” and “the” are intended to includeboth the singular and the plural forms, unless the context clearlyindicates otherwise.

As used herein, the term “and” and “or” are understood to include bothinclusive and non-inclusive understandings of these conjunctions. Forinstance, the conjunctions “and” and “or” should be understood asencompassing any of the options independently or any combination of theoptions in concert, unless the context clearly indicates otherwise.

As used herein, the terms “comprises”, “comprising”, “includes”,“including”, or any variation thereof, are intended to reference anon-exclusive inclusion, such that a process, method, article,composition, or apparatus that comprises a list of elements does notinclude only those elements recited, but may also include other elementsnot expressly listed or inherent to such process, method, article,composition, or apparatus.

Directional or positional terminology, such as “top,” “bottom,” “front,”“back,” “leading,” “trailing,” etc., is used with reference to theorientation of the figure(s) being described. Because components ofembodiments of the present invention can be positioned in a number ofdifferent orientations, this terminology is used for purposes ofillustration and is in no way limiting. Other combinations and/ormodifications of the above-described structures, arrangements,applications, proportions, elements, materials, or components used inthe practice of the present subject matter, in addition to those notspecifically recited, may be varied or otherwise particularly adapted tospecific environments, manufacturing specifications, design parameters,or other operating requirements without departing from the generalprinciples of the same.

As used herein, the terms “distal” and “proximal” are understood aspositional referents. Objects, elements, and components are “proximalto” or “distal to” one another on the system. “Proximal” refers to adirection toward the system controls and the operator along the path ofthe catheter system, and “distal” refers to the direction away from thesystem controls and the operator along the path of the catheter systemtoward or beyond a terminal end of the operating head.

As used herein, the term “dynamic” refers to a state opposed to, oropposite to, a static state. For instance, a dynamic shearing forceoscillates between a high and low force. Furthermore, the term “dynamic”indicates a measured approach; an approach designed to optimize thedesired results. In one embodiment, an algorithm may determine or adjustin real-time the oscillation of a dynamic state to optimize results.

As used herein, the term “occlusion” refers to both partial vesselocclusion and complete vessel occlusion. Examples of partial vesselocclusion include a vessel that is narrowed by hardened substances, suchas plaque. Additionally, as used herein, the “complete” removal of anocclusion is understood as an effective removal of thrombus. Occlusivematerial may escape removal, while a person having ordinary skill in theart would characterize the removal as complete in that the device hasrestored patency to the vessel.

As used herein, the terms “blade” and “cutting member” are understood toinclude any cutting device that achieves a substantially similar resultto a cylindrical blade characteristic of a bore drill or hole saw. Theterm “blade” refers to both the cutting edge and the supportingcylinder. The term “blade” is understood to include any polyhedral thatachieves a substantially similar result. For instance, the blade mayhave as few as one side; a blade may have three sides, such as in atriangular cylinder, eight sides, such as in an octagon cylinder, or anynumber of sides above or between these two variations. Alternatively,the shape of the “blade” is not necessarily a shape with even-symmetrybut instead may be of a conic shape, n-ellipse shape, or superellipseshape. Furthermore, “blade” is not to be understood as limited to solidcylindrical shafts, instead “blade” should be understood as encompassinga cutting edge structurally supported by any framework thatsatisfactorily maintains the desired shape and rigidity of the cuttingedge. For instance, an annular blade supported by a series of pillars,ribbons, or cross-hatched wires (e.g. chicken wire) is understood tofall within the definition of “blade” as used herein. However, as theirplain meaning would indicate, a “cutting member” refers to a broaderclass of cutting instruments than a “blade,” and a “cutting member”should be understood as fully including all variations of the “blade” asdescribed above.

As used herein, the term “cone” is understood to include any shape thatcan engage against the blade or cutting member to a satisfactory degreeas the blade either rotates and/or actuates, including anything betweena two-dimensional triangular edge and a spherical cone. The term “cone”is also understood to include any juxtapositions of multiplenearly-two-dimensional triangles whose juxtaposed base forms any shapebetween a rectangle and a circle. Additionally, the cone could bereplaced with a flat-face, a spherical surface, or a cylindrical punchand still fall within the scope of this invention. Such shapes mayperform sub-optimally, but they are within the spirit and scope of thedevice's method of clot fragmentation between two, variably positionednon-biological surfaces. The cone may optionally be comprised of a metalalloy, a ceramic, or a polymer. While cones having pointed apices ortips are illustrated and will be commonly employed, truncated and otherconical geometries may also find use.

As used herein, an aspiration source may refer to any device thatsupplies a negative pressure gradient. The source of negative pressurecould be a vacuum pump, peristaltic pump, a diaphragm pump, apiston-based pump, a high-speed water jet disposed at a proper angle andorientation to create a favorable negative pressure gradient, or asimple syringe. All variations are understood to fall within the scopeand spirit of the present invention.

Some aspects of the present subject matter may be illustrated viafunctional block components and various processing steps. Suchfunctional blocks may be realized by any number of techniques,technologies, and methods configured to perform the specified functionsand achieve the various results. The systems described are merelyexemplary applications. Furthermore, any particular order to thefunctional blocks is merely illustrative of one possible order for thesteps described. It will be appreciated that methods described andillustrated may be performed in any order and/or simultaneously withoutdeparting from the scope of the present invention, disclosure, orclaims.

Referring now to the drawings in detail, there is depicted a preferredembodiment of the apparatus of the invention, which is useful for theremoval of objects that restrict healthy flow such as thrombus, bloodclots, atheroma, gallstones, kidney stones, purulent material fluid,polyps, cysts or other obstructive matter from body lumens, such asblood vessels, ureters, bile ducts, or fallopian tubes. The numeralsassigned to each element indicate the figure being referenced. Forinstance, numerals in the 100's reference FIG. 1 and numerals in the400's reference FIG. 4.

FIG. 1 illustrates a perspective view of one embodiment of the presentinvention's thrombectomy catheter system 100. System 100 includesspecialized catheter 102 attached to base unit 107 that houses motorizedcomponents that are operated by a user to effectuate working internalcomponents (not visible in FIG. 1) of specialized catheter 102 of system100. A distal end 102 a of the catheter 102 is inserted into a vein,artery, or other passageway, advanced to a treatment site, and thendeployed to mechanically disrupt, fragment, and aspirate a targetsubstance(s) from the passageway. An atraumatic tip 101 is disposed at adistal end of catheter 102. Tip 101 reduces the risk that the passagewaywill be damaged by the insertion and placement of catheter 102. Anaperture 103 is located near the distal end of catheter 102. Aperture103 permits substance(s) from the patient's body to enter an aspirationlumen formed in the catheter 102. A proximal end 104 of catheter 102 iscoupled to a motor 105 that provides rotational and/or reciprocal axialmotions to internal components of catheter 102, as discussed in greaterdetail below. The proximal end 104 of catheter 102 is in fluidcommunication with an aspiration source, such as pump 106, that providesa negative pressure gradient (e.g. vacuum suction) which draws and thetarget substance(s) through aperture 103 and into the aspiration lumenof the catheter 102. Other known aspiration sources may be used withinthe scope of this invention. Together, the negative pressure gradientand the mechanical fragmentation ensure the efficient and effectiveremoval of substances from the body. In alternative embodiments, system100 may include more than one pump or valve in fluid communication withsystem 100. Such pumps and valves may provide or remove fluids in a waythat alters the pressure within system 100. System 100 may be controlledby an ergonomically shaped handle (not pictured in FIG. 1) that housesmotor 105 and either houses or is in fluid contact with pump 106. Thisallows the user to easily control and manipulate system 100.

FIG. 2 illustrates one embodiment of a distal region 200 of a catheterconstructed in accordance with the principles of the present invention.The distal region 200 is shown as transparent in order to facilitate anunderstanding of its internal components. Distal region 200 has anaperture 202 configured to draw in thrombus or another target substance201, as shown partially within aperture 202. The target substance 201 isdrawn into aperture 202 by an aspiration source (such as pump 106 inFIG. 1) that provides a negative pressure gradient within a lumen 203 ofthe catheter. An opposing surface in the form of cone 205 is locateddistal to aperture 202, where a tip 205 a of cone 205 is pointingproximally. In alternative embodiments, an opposing surface or cuttingsurface may be in the shape of a bulb or other suitable form. In someembodiments, a portion of cone 205 may be visible through aperture 202,even without the benefit of a transparent illustration. Also visible inFIG. 2 just proximal of aperture 202 is a blade 204. Blade 204 istypically cylindrical and configured to be rotated and/or to betranslated in both axial directions. Blade 204 may be further configuredto circumscribe, superimpose, surround or otherwise mate with a cone205, where the cone may have a diameter at or near its base whichapproximates an inner diameter of a leading, cutting edge 204 a of thecylindrical cutting blade 207. The cutting edge 204 a of blade 204, insome embodiments, may contact an opposing surface of cone 205 as theblade is brought axially forward, as shown in FIG. 6C discussed below.Alternatively, an interior surface of the distal region 200 of thecatheter may be configured to present a transverse flat or otheropposing surface (not illustrated), and the cutting edge of blade 204may contact this opposing surface when blade 204 is moved to its mostdistal axial position. During use of a catheter having distal region200, the substance 201 will be broken apart or fragmented by shearing orother interactions between blade 204 and the opposing surface, or cone205. Fragments of the target substance 201 are drawn into and throughlumen 203 to a proximal region of the catheter where they may be removedfrom the body of the patient.

As will be discussed in greater detail below, as a substance is drawn byan aspiration source into aperture 202 and the blade 204 is distallyadvanced (usually while simultaneously being rotated or rotationallyoscillated) to the opposing surface of cone 205, the substance is caughtbetween and is subjected to shearing forces (see FIG. 9A-D) thatfragment the substance. The resulting fragments are then drawn by theaspiration source into lumen 203 of catheter 200. The cooperativeinteraction of these components and elements allow system 100 to ingestlarge substances. The substances are broken up within the system andingested, while aspiration ensures that minimal, if any, residualsubstance is permitted to escape evacuation. Once the substance 201 orportion thereof is inside lumen 203 of the catheter, aspiration drawsthe substance through the lumen and into a collection chamber (notpictured).

A soft, atraumatic distal tip 207 allows for the safe advancement of thedevice through the diseased vessel. A forward or leading edge of thecutting blade 204 is typically serrated or otherwise configured topromote cutting of the target substance as the blade is advanced andoptionally rotated or rotationally oscillated and further configured topromote shearing of the excised portion of the target substance from theremaining mass of target substance as the leading edge engages the coneor other surface within the distal region 200 of the catheter.

The aperture 202 is typically formed as a “side window” in the distalregion 200 of the catheter, and the cutting blade 207 may be advancedand retracted to adjust the size of a gap between the cutting body andthe distal end of the window. Aspiration pulls the target substance,such as clot material, to the open window, and the rotating cuttingblade 207 fragments the clot as it enters the window. A motor whichrotates or rotationally oscillates the cutting blade will typically beattached to a proximal end of the catheter, as shown for example in FIG.1, and may be housed in an ergonomically designed handle. The aperturemay be formed in a separate structure at the distal end of the catheter,such as in a separate housing. For example, the separate housing may bea metal or rigid polymeric tube having the aperture formed therein.

The distal end of the distal region of the catheter is typically closedand has a cone 205 with a conical tip 205 a attached thereto. Theconical tip 205 a is tapered or pointed and faces in a proximaldirection. The leading edge 204 a of the cutting blade 204 is receivedover the cone 205 as the blade is advanced distally to cut targetsubstances received through the aperture 202. Shearing action of therotating cutting body against the outer surface of the cone, andadvancement and retraction of the cutting body over the cone, furthermacerates the clot.

The device is intended to be used by a physician trained ininterventional techniques. In some instances, an assisting technicianmay operate the handle while the physician drives the catheter.

FIG. 2 further illustrates a spring 206 secured to the distal end of thecatheter and covered in polymer to form the soft, atraumatic tip 207. Inalternative embodiments, the spring 206 of the atraumatic tip may bereplaced with an alternative metallic backbone (being either a metal ormetal alloy). For instance, the atraumatic tip may achieve a tapered,gradual stiffness profile by utilizing a pine tree shape, a rod with asphere, oval, cube, cone, or conic profile on the distal tip, a springwith multiple and varied wind diameters, a spring with multiple, variedpitches, or a hypotube with numerous laser cuts. In alternativeembodiments, the metallic backbone may be shaped to have a bend or arc.Such a shape assists with selecting the desired vasculature at juncturepoints. The metallic backbone ensures that the catheter tip maintains ashape important to its function, while also providing the flexibilitynecessary for the delicate areas the apparatus traverses. This novelsoft, atraumatic tip 207 ensures that the distal edge of catheter 200can enter the passageways of the body without causing damage to thepatient. This tip improves on prior art systems that utilize a polymerictip by allowing a greater degree of flexibility while still returning tothe desired shape absent external pressure. Additionally, this tipimproves on prior art by allowing a secure metal-on-metal connectionbetween the catheter and the atraumatic tip. This feature avoids theissue of losing the tip within the patient during surgery, a seriousissue that has occurred with prior art devices. In alternativeembodiments, the atraumatic tip has a lumen with a valve on the distaltip, which allows a guidewire to pass through while maintaining a vacuumseal in its absence. In further alternative embodiments, a second lumencoextends with the catheter and houses a guidewire. Alternatively, theguidewire may extend within the lumen of the catheter and exit from thecatheter's aperture.

FIG. 3 illustrates an alternative distal region 300 of a catheterconstructed in accordance with the principles of the present invention.Catheter 300 has a distal edge 301. Onto distal edge 301 atraumatic tip307 is optionally attached. Distal region 300 has an aperture 302.Aperture 302, as shown in this embodiment, is only illustrative of onepossible shape and is not meant to be restrictive in any manner. Inalternative embodiments, the aperture may be any shape that serves as ameans of ensuring structural integrity, while also allowing largesubstances to at least partially enter. For instance, the aperture mayhave many openings with one or more sidewalls providing structuralintegrity between each individual aperture. The aperture may have anyone of a square shape, a triangular shape, a circular shape, anelliptical shape, an eye-lid shape, or any shape in-between. While inuse, target substances are drawn from the passageways of the body intoaperture 302 by a negative pressure gradient force supplied by anaspiration source in fluid communication with a proximal end of thecatheter (not visible in FIG. 3). The lumen 303 of the catheter lumen isshaped cylindrically and includes a sidewall 304. The distal catheterregion 300 will optionally include a section of radiopaque material.FIG. 3 illustrates a T shaped radiopaque marker 305. The radiopaquemarker may be of an L or T shape that outlines a portion of theaperture, may be formed of multiple L or T shapes, and may wrap aroundthe entire circumference of the catheter as a complete band or a Cshape. Alternatively, the radiopaque marker may be shaped in the form ofa dot near a cross placed near the system's aperture. The radio opaquematerial may comprise a metal selected from the group consisting ofplatinum, gold, and similar dense alloys. This will allow the attendingphysician to easily view the distal end of the catheter 300 as it isinserted into and maneuvered within the patient.

FIG. 4 illustrates one embodiment of a cutting blade 400 that may beused with any of the an exemplary catheters described herein. Blade 400is shown independently of a specific catheter system so that details ofthe blade are more readily observed. A leading cutting edge 401 of blade400 is serrated, having teeth 401 a that may be of a variable pitchand/or a spiral cut pattern. Alternatively, the teeth 401 a of the blademay be irregular and may have consistent or inconsistent gaps betweenteeth to promote variable sheering forces at any given time in thesystem's operation. In other embodiments, the teeth may be curved andserrated, like shark teeth, or they may be blunted, rounded, or have asinusoidal profile depending on the physical properties of the substancetargeted for removal. Blade 400 may include a cylindrical lumen 402.Alternatively, the lumen of the blade may be of a triangular,rectangular, pentagonal, hexagonal, etc. shape. In alternativeembodiments, the blade may have a lumen with a conical shape, anelliptical shape, or a super-elliptical shape. The shape of the blade'slumen will dictate the shape and dimension of the blade's distal edgewhere the teeth of the blade are located. Blade 400 tapers at itsproximal end for attachment to a mandrel 403, which is optionallycovered in a lubricous sheath. Alternatively, blade 400 could have acylindrical or other body that extends the full length of the catheter,whereby the clot or thrombus remains inside the lumen of the cuttingstructure for the full length of its travel through the catheter.Mandrel 403 is driven by a motor that supplies both rotational(including rotational oscillation) 404 and/or reciprocal axial 405motions. The motion imposed on the mandrel by the motor will typicallybe selected to cause the blade 400 to move in a way that promotesfragmentation of the occlusive material.

FIG. 5 illustrates an exemplary cone 500 which provides an opposingsurface 500 a that is useful in a system according to the invention. Thecone 500 is shown separately from a catheter so that details of the coneare more readily observed. Cone 500 has tip 501 and base 502, with theopposing surface 500 a extending between the tip and the base. Tip 501terminates in a point with an inner angle 503 of between 15° and 120°.In alternative embodiments, the cone may have any number of a number ofshapes which are suitable as an opposing surface to a cutting edge ofthe cutting blade. Exemplary alternatives include an elliptical cone, acone with a conical base, a cone with a triangular base, or a cone witha base having more than three sides. In one embodiment, cone 500 guidesblade 400 through a lumen of a catheter to a distal edge of thecatheter. This guiding feature ensures that the blade stays within thelumen and does not emerge from though a cutting aperture, therebyreducing the risk of the blade coming into contact with the vasculatureof the patient. The cone also serves as an opposing surface into which asubstance, such as a thrombus, is held against while the device's bladerotates and pushes into the substance. The cooperative action of theopposing surface and blade generate shearing forces over and above thoseseen in the prior art. These additional shearing forces make the devicemore effective at removing tough clots and more resilient againstclogging. In alternative embodiments, the cone has a lumen and is hollowthrough the center. Such a design allows a guidewire to pass through thesystem.

FIGS. 6A-6C illustrate blade advancement and rotation during use of acatheter 606 of the present invention having a distal region 600. Thethree illustrations show axial advancement and reciprocation of theblade with the various positions of the blade within the catheterproviding a desired non-constant shearing and axial forces that serve toshear a target substance and allow for the quick and effectivefragmentation of the target into relatively uniformly sized pieces whichcan be safely removed from the body.

FIG. 6A illustrates a first stage in the progression. The distal end 600of the catheter 606 is shown as transparent in order to better visualizea cone 605 and a cutting blade 604. The cone 605 and the cutting blade604 are disposed within a catheter lumen 608. In FIG. 6A, an aperture603 is shown as completely open. Cutting blade 604 has a forward cuttingedge defined by teeth 601 which are shown facing distally as the bladeis in its proximal most position where it is disposed inside a lumen 608of catheter 606 and is not visible in aperture 603. A lumen 617 isformed axially through the cutting blade 604. Cutting blade 604 isaxially reciprocatable in opposed distal and proximal directions asillustrated by arrow 609. Cutting blade 604 is also mounted to rotate,as illustrated by circular arrow 610. Cone 605 is shown near a distalend of the distal region 600 of the catheter 606 with its opposingsurface 605 a and tip 605 b facing proximally. A mandrel or shaft 607 isconnected to a proximal edge 604 a of blade 604. Mandrel 607 is drivenby a motor (such as, for example, motor 105 of FIG. 1), that causesrotation and/or rotational oscillation in the direction of arrow 610 (orin an opposite direction in the case of full rotation). The motor mayalso drive axial reciprocation or single pass movement in the directionof arrow 609 of connected blade 604. In some instances, however, theaxial reciprocation could be manually driven, e.g. by a slide on thehandle (not shown).

FIG. 6B illustrates a second stage of the progression, in which themoving components of the embodiment are in a second position. In thisstage, aperture 603 is shown as halfway closed as blade 604 advancesdistally according to axial motion 611 within catheter 606 towards cone605. During axial motion 609, blade 604 may also undergo continuous ordynamic (oscillatory) rotation 610. As blade 604 approaches the opposingsurface of cone 605, a substance, such as a thrombus, (not pictured),will be drawn into the lumen by aspiration forces and compressed betweenthe blade and the cone. The distal tip 605 a cone 605 can pierce athrombus, while blade 604 advances towards the thrombus to pierce, tear,cut, and otherwise fragment the thrombus.

FIG. 6C illustrates a third stage of the progression. In this stage,aperture 603 is shown as closed 612. Blade 604 has fully advanceddistally, according to axial motion 611, and cone 605 is now disposedwithin lumen 617 of blade 604. At this point, in clinical use, anythrombus or comparable substance between blade 604 and cone 605 would besubjected to the maximum shearing force of the device. The leading edgeof blade 604 having teeth 601 closely approaches or directly contactsthe opposing surface 605 a of cone 605, usually near the base of cone605, to maximally compress and to cut any target substance caughtbetween. The conical tip 605 b and conical shape of the opposing surface605 a of cone 605 pierce and force a portion of a target substance intothe teeth 601 and then into lumen 617 of the blade 604. Additionally,the cone 605 acts as a backstop against which the blade rotates.Together, the blade 604 and the cone 605 provide two surfaces betweenwhich a portion of the target substance is cut into fragments.

In exemplary embodiments, the diameter of blade 604 may approximate theouter diameter of cone 605 at any point along the exterior of cone 605,up to the largest diameter at the base of cone 605. The optimal diameterof blade 604 may be further determined by the best fit between innerdiameter of catheter 606 and an outer diameter of cone 605 near the baseof cone 605. Immediately after the configuration illustrated by FIG. 6C,the reciprocal axial motion of the blade 605 would cause the blade toretract to its most proximal position as shown in FIG. 6A beforerepeating the steps of FIGS. 6B and 6C again, typically at a rate up toapproximately 6 Hertz. The interaction between the cone and blade hasthe benefit of providing a mechanism that works in concert withaspiration. Aspiration causes portions of large substances to partiallyenter the catheter. The synchronized action of the blade and conefragment the drawn substance, or piece thereof, thereby allowingaspiration to draw the fragments completely through the catheter to thecollection chamber. This synchronized action increases the effectivenessof the system's clot removal features. The clots attacked are drawn in,fragmented, and aspirated through the lumen in repeated cycles.

The present invention utilizes a cyclic function, as illustrated inFIGS. 6A-6C. The cone and blade operate to open and close the aperturerepeatedly. The cone and the blade have complimentary shapes that slideinto one another to mate and subject anything caught in between tobi-modal shearing forces that result in discreet fragmentation. Thesetwo components cause the targeted substance to be digested between twonon-biological, non-clot surfaces. While typical prior art devicesfragment substances between the surface presented by the device and thesurface presented by the vasculature wall behind the target, i.e.between a one non-biological surface and one biological surface. Such aprior art method requires that the fragmenting machinery be housed onthe outside of the device, where it risks inadvertently contacting apatient's vasculature. Many aggressive devices designed to treat large,tough, and dense biological substances include rotating blades orabrasive tips, which are exposed on the outside of the catheter wherethey pose a risk of damaging vasculature. The present invention includesthe benefits of these prior art aggressive cutting mechanisms withouttheir respective drawbacks. The present invention achieves this byhousing the components responsible for fragmentation safely within thecatheter, where it is not at risk of contacting a patient's vasculature.

FIG. 7 illustrates a diagram of another embodiment of a method for theremoval of targe substances from a passageway or body lumen, such as ablood vessel, of a patient. As depicted in FIG. 7, a first step is theinsertion 701 of a catheter within a passageway of the patient. A secondstep is the placement 702 of the catheter in the appropriate position sothat the catheter comes within close proximity of a targetedsubstance(s). A third step is to aspirate 703 so that the substance(s)is drawn towards an aperture of the catheter. A fourth step is to causereciprocal axial movement in a blade 704 in order to pinch, shear, andotherwise tear off a substance or portion thereof. A fifth step is tocause rotational movement in the blade 705 in order to shear, cut, rip,and otherwise tear off a substance or portion thereof. A sixth step isto repeat any of the other steps as necessary 706. Tough, calcified, orother wised hardened deposits or plaques may require repeated cathetertreatments 702 as portions of the substance are evacuated. In addition,the move towards additional portions of the target substance willrequire repeating aspiration steps 703 and/or blade movements 704, 705.It should be appreciated that these steps can be skipped, performed inany order, performed simultaneously, or include intervening steps andstill fall within the scope of the present invention and itsequivalents.

FIG. 8 illustrates a diagram of another embodiment of a method for theremoval of substances from the passageways of a patient. As depicted inFIG. 8, a first step is to advance a catheter to the substance 801 thatis intended to be evacuated. A second step is to aspirate 802, so that asubstance(s) is drawn into an aperture of the catheter. A third step isto engage a blade and cone 803 so they come together and move apart at aparticular or variable frequency while also employing rotational motion.A fourth step is to repeat any steps as necessary 804. Again, it shouldbe appreciated that these steps can be skipped, performed in any order,performed simultaneously, or include intervening steps and still fallwithin the scope of the present invention and its equivalents.

FIGS. 9A, 9B, 9C, and 9D show an embodiment of the present invention ina vertical orientation to illustrate an example of some axial shearingforces that a substance, such as a thrombus or clot, undergoes within asystem according to the present invention. FIG. 9D shows the relativelyuniform fragmentation that the cyclic nature of the axial shearingcauses.

FIGS. 9A and 9B illustrates a system 900 at a first point in time, whensystem 900 is in a first configuration, prior to axial compression ofthrombus 904, and FIG. 9C illustrates system 900 at a second point intime, when system 900 is in a second configuration, during axialcompression of a thrombus. For clarity, not all features of a systemaccording to the invention are included in FIGS. 9A, 9B, 9C, and 9D.System 900 includes blade 902 and opposing surface, or cone 903. InFIGS. 9A and 9B, blade 902 and cone 903 have not yet come into contactwith a soon-to-be trapped substance, which in this example shall bereferred to as clot 904. Within clot 904 a fitted line 905 showing alinear approximation extends through the center of the clot. Prior toany deformation caused by blade 902 and cone 903, fitted line 905resembles a straight line. This line is meant to indicate the axialforces being applied to the clot at this point in time.

Turning to FIG. 9C, a force 907 has pushed blade 902 into clot 904. Theforce applied to blade 902 is transferred to clot 904 which is therebydeformed. The clot 904 often deforms in a shape 905 which approximatessinusoidal, as shown in FIG. 9C. Of course, such a sinusoidaldeformation results from only a portion of the axial forces experiencedby the clot. This narrow focus permits a clear illustration of anexemplary example of the some of the major axial shearing forces a clotwill be subjected to between a blade and cone.

Starting from the left, clot 904 experiences a downward force,illustrated by the left side of the sinusoidal approximation (fittedline 905). Above the left side of the sinusoidal approximation on clot904 a hogging moment 911 is shown by a “−M” and two upward-curvedarrows. Above the right side of the sinusoidal approximation a saggingmoment 910 is shown by a “+M” and two downward-curved arrows. The arrowsof these moments mirror a sinusoidal wave, because the left side of theclot experiences a downward force from blade 902 while the center of theclot (or the right side of sinusoidal approximation) experiences anupward force from the cone. These forces act in opposite directions andtherefore cause a shearing force in between. This shearing is shown onclot 904 by two half-headed arrows 912 indicating a counter-clockwiseshearing force. On the other side of the clot 904 another shearingforces is shown 913 that indicates a clockwise shearing force. A personhaving ordinary skill in the art can appreciate upon reflection that aclot caught in such a situation would experience a variety of additionalshearing forces similar to those detailed. For instance, thistwo-dimensional sinusoidal approximation would form a plane if rotated360 degrees. The forces described in reference to points on thetwo-dimensional illustration could then be described as a ring offorces. This ring of forces more accurately represents the type of axialforces the clot is subjected to.

The utilization of axial shearing forces in this manner is novel to thefield of devices and methods for disrupting, collecting, and removingocclusive material from blood vessels and other body lumens. Othercatheters utilizing rotating blades are not benefiting from the axialshearing. This axial shearing is particularly beneficial because itenables a bi-modal shearing force which is substantially more effectiveat disrupting the structure of the target substance. The bi-modalshearing force combines rotational and axial cutting to enable completeand controlled fragmentation.

FIG. 9C illustrates the axial shearing force, but not the rotationalshearing force. As clot 904 is trapped between blade 902 and cone 903,blade 902 rotates and imparts a rotational shearing force on the clot904. The blade side of the clot 904 is sheared as to the opposite sideof the clot, which at least partially resists the rotational forcebecause of the cone's pressure. Pressure to turn on one side and aresistant force on the other causes a shearing of the material betweenas the individual fibers of the clot begin to slide past one another.The inside of the clot experiences a rotational shearing force acrossthe entire length of the blade's teeth (not pictured). The combinationof this rotational shearing force and the axial shearing force (bi-modalshearing) serves to efficiently and effectively fragment and digest eventhe toughest clots.

FIG. 9D shows the discreet and relatively uniform fragmentation that thecyclic nature of the axial shearing causes. The axial motion of cuttingmember 902, which ultimately places the cutting edge of cutting member902 into contact with cone 903, causes the fragmentation of clot 904. Ascutting member 902 moves distally, clot 904 may be sliced alongperforated line 914. This slicing creates a discreet and relativelyuniform fragment, which is then immediately aspirated. As the cuttingmember fragments the clot, the fragment generated is aspirated throughthe cutting member's lumen in a proximal direction. The relativelyuniform fragments 915 are then further aspirated in a proximal direction916 within the catheter's lumen. This fragmentation occurs within thecatheter's lumen, and thereby reduces the risk of clot fragmentdispersal within the patient's vasculature.

An apparatus according to the present invention will comprise cathetersadapted for intraluminal introduction into the target body lumen. Thedimensions and other physical characteristics of the catheter will varysignificantly depending on the body lumen which is to be accessed. Inthe case of catheters intended for intravascular introduction, thecatheter will typically be flexible and may be compatible withintroduction over a guidewire to a target site within the vasculature.In particular, catheters can be intended for “over-the-wire”introduction when a guidewire lumen extends fully through the catheterbody or for “rapid exchange” introduction where the guidewire lumenextends only through a distal portion of the catheter body. The presentinvention may also be introduced using a sheath.

Benefits, advantages, and solutions to problems have been describedabove with regard to particular examples. However, any particularbenefit, advantage, or solution is not to be construed as critical,required, or essential. Nor is any particular element that may cause oramplify a benefit, advantage, or solution to be construed as critical,required, or essential.

In the foregoing description, the subject matter has been described withreference to specific exemplary examples. However, it will beappreciated that various modifications and changes may be made withoutdeparting from the scope of the present subject matter as set forthherein. The description and figures are to be regarded in anillustrative manner, rather than a restrictive one and all suchmodifications are intended to be included within the scope of thepresent subject matter. Accordingly, the scope of the subject mattershould be determined by the generic examples described herein and theirlegal equivalents rather than by merely the specific examples describedabove.

The examples illustrated have been described to promote clarity ofunderstanding, and it will be obvious that any equivalent modificationswill fall within the scope of the appended claims. Equivalentmodifications are understood to include, but not be limited by, thefollowing examples: (1) performing the steps recited in a method in anyorder or skipping steps altogether, (2) varying dimensions and materialswithin reasonable limits, (3) varying the configuration of elements inway that achieves substantially the same result, and (4) combiningdifferent embodiments in a way that achieves substantially the sameresult.

The present invention, and the embodiments illustrated herein, makessubstantial, non-obvious improvements over the prior art. The presentinvention fragments target substances in a discreet, bite-like manner.The target substance is drawn into the catheter's lumen, and only thendoes fragmenting occur. The complimentary geometries of the blade andcone enable the device to function like teeth in a mouth. Thefragmentation occurs safely within a defined space. The blade and conecome together and impart bi-modal shearing forces (both rotational andaxial shearing forces) to fragment a discreet chunk of material. Thediscreet fragment is then immediately aspirated further within thedevice's lumen. The cycle of cutting the substance and aspirating afragment is then repeated. This improves on prior art where the devicesfragment target substances within the vasculature, whereby the fragmentsare simultaneously dispersed throughout the vasculature. Such dispersalcan cause further complications that the present invention avoids. Thepresent invention does not release fragments within the vasculature. Thecreation of the fragments is simultaneous with their removal. Putanother way, the present invention improves on prior art by capturingrelatively uniform fragments of a targeted substance at a rate equal tothe catheter's ability to ingest and clear away the fragmented pieces.The fragments are thereby immediately removed, rather than dispersedinto the patient's vasculature.

1. A system for removal of one or more target substances from a bodypassageway, the system comprising: a catheter having a lumen, a proximalend, and a distal end, wherein a proximal end of the lumen is configuredto be fluidly coupled to an aspiration source; a cutting member having aleading cutting edge, the cutting member disposed in the lumen andconfigured for axial motion within the lumen between a proximal-mostposition and a distal-most position; and an opposing surface disposedwithin at a distal location in the lumen, wherein the leading cuttingedge of the cutting member is configured to contact the opposing surfaceand to shear target substance disposed between the leading edge and theopposing surface when the cutting member is positioned in the distalposition; wherein the opposing surface comprises a cone disposed distalto the cutting member, wherein the cutting member is configured so thatthe leading cutting edge of the cutting member engages a conical surfaceon the cone as the cutting member is advanced fully in a distaldirection.
 2. The system of claim 1, wherein the cutting member isfurther configured for rotation and/or rotational oscillation.
 3. Thesystem of claim 2, wherein the system further comprises at least onemotor coupled with the cutting member, wherein the at least one motor isconfigured to impart both rotational motion and reciprocal axial motionto the cutting member.
 4. The system of claim 3, wherein the at leastone motor is configured to rotate the cutting at a speed of up to 3000RPM.
 5. The system of claim 4, wherein the at least one motor isconfigured to axially reciprocate the cutting member at a frequency ofup to 6 Hz.
 6. The system of claim 1, wherein the cutting member iscylindrical with a leading cutting edge.
 7. The system of claim 6,wherein the leading cutting edge has cutting teeth.
 8. (canceled)
 9. Thesystem of claim 1, wherein a base of the cone is attached to a distalend of the catheter and a pointed conical tip of the cone is directedproximally.
 10. The system of claim 9, wherein the cone is configuredfor rotational motion.
 11. The system of claim 1, wherein the catheterincludes an atraumatic tip.
 12. The system of claim 11, wherein theatraumatic tip comprises a metallic backbone and a polymeric material.13. The system of claim 12, wherein the metallic backbone comprises apreselected angle or arc.
 14. The system of claim 12, wherein themetallic backbone comprises a wound spring.
 15. The system of claim 1,wherein the cutting member and the opposing surface are configured tofragment a targeted substance into fragments having discreet andrelatively uniform volumes upon axial motion of the cutting member. 16.A system for removal of one or more substances from a body passageway,the system comprising: a catheter having a lumen, a proximal end, adistal end, and a sidewall, wherein the sidewall comprises an aperturedisposed near the distal end of the catheter; a cone having a base and atip, the cone positioned at the distal end of the catheter, wherein thebase of the cone is oriented toward the distal end of the catheter andthe tip of the cone is orientated toward the proximal end of thecatheter; and a distally facing cutting member disposed in the lumen ofthe catheter, the cutting member configured for reciprocal axialtranslation in both a distal direction toward the cone an a proximaldirection away from the cone.
 17. The system of claim 16, wherein thesystem further comprises a motor configured to impart axial motion tothe cutting member.
 18. The system of claim 16, wherein the cuttingmember is further configured for rotation and/or rotational oscillation.19. The system of claim 18, wherein the system further comprises a motorconfigured to imparts both axial and rotational motion to the cuttingmember.
 20. The system of claim 16, further comprising an aspirationsource in fluid communication with the catheter.
 21. The system of claim16, wherein the cutting member is configured to rotate at a speed of upto 3000 RPM.
 22. The system of claim 16, wherein the cutting member isconfigured for axial translation at a frequency of up to 6 Hz.
 23. Thesystem of claim 16, wherein the cutting member is cylindrical with aleading cutting edge.
 24. The system of claim 23, wherein the leadingcutting edge has cutting teeth.
 25. The system of claim 16, wherein thecone has a conical surface disposed distal to the cutting member,wherein the cutting member is configured so that the leading cuttingedge of the cutting member engages the conical surface on the cone asthe cutting member is advanced fully in a distal direction.
 26. Thesystem of claim 16, wherein the cone is configured for rotationalmotion.
 27. The system of claim 14, wherein the catheter includes anatraumatic tip.
 28. The system of claim 27, wherein the atraumatic tipcomprises a metallic backbone and a polymeric material.
 29. The systemof claim 28, wherein the metallic backbone comprises a preselected angleor arc.
 30. The system of claim 28, wherein the metallic backbonecomprises a spring.
 31. The system of claim 16, wherein the cuttingmember and the cone are configured to fragment a targeted substance intofragments having discreet and relatively uniform volumes upon axialmotion of the cutting member.
 32. A method for removing a targetsubstance from a body passageway, the method comprising the steps of:providing a catheter comprising a lumen and a cone and a blade disposedin a distal end of the lumen, advancing the distal end of the catheterto a target substance in the body passageway; initiating aspirationthrough the lumen to draw the target substance between a cutting edge ofthe blade and an opposing conical surface of the cone; axiallyreciprocating the blade so the blade engages the target substance andshears the target substance against the opposing conical surface of thecone.
 33. The method according to claim 32, further comprising rotatingthe blade to enhance shearing of the target substance.
 34. The methodaccording to claim 32, wherein the target substance is penetrated by aconical tip on the cone as the blade is axially reciprocated.
 35. Themethod according to claim 32, wherein initiating aspiration through thelumen draws the target substance though an aperture in a sidewall of thecatheter and then into a space between t cutting edge of the blade andthe opposing conical surface of the cone.